| NPI | 1699016006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130120) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2013-03-09 |
| Last Update Date | 2024-02-14 |